“The closest thing the UK has to a national religion” is the phrase often attributed to Nigel Lawson. It’s unclear how accurate that attribution is, but the statement is true: for to question the NHS is blasphemy in British politics.
You can introduce free schools, you can privatise the railways, and you can privatise the Royal Mail, but don’t talk about challenging the fundamentals of the NHS.
Even reforming the NHS to allow for the possibility private provision of some services, then you face accusations from the opposition, from the NHS lobbyists representing both professionals and advocates, of “destroying” the NHS, and even worst “Americanising our health system”.
Few areas of public policy in the UK are so subject to what is effectively emotional blackmail by those with a vested interest in the status quo, and the large network of advocacy and voluntary groups who are thoroughly convinced that the alternative to the NHS is a perceived dark future of replicating the United States.
It is nonsensical, but difficult for politicians to deal with. So effective are the rent-seekers in the health professions, the health sector unions and the Labour Party (which being the parent, guards its baby by all means possible) that David Cameron had to declare that the Conservative Party would be a party of the NHS. The promise to “ringfence” funding of the NHS was a deliberate effort to silence the lobbyists.
Yet the NHS does not represent the “envy of the world” that its propagandists portray it to be – far from it. The latest story from the NHS is that of Walter Coles, who spent three days at Wycombe Hospital not even seeing a doctor, before he died and according to the Daily Telegraph “a chart detailing what medication he should be given went missing – before being filled out again by a doctor who hadn’t examined him.”
The stories from Mid-Staffordshire hospital, including revelations that negligence had substantially contributed to the death of 1,200 patients, and the degradation of many more, would have caused outrage had a fraction of such cases been seen at a private hospital.
When structural failures and negligence saw the Hatfield rail accident kill 4 people and injure 70, it saw an inquiry into the rail industry that eventually wound up the rail infrastructure company Railtrack, replacing it with Network Rail. All because Railtrack had inadequate maintenance records and an incomplete asset register, so was incapable of holding its contractors responsible for failing to safely maintain its network. Network Rail as successor agency was taken to court for manslaughter, along with its contractors, and ultimately they were found guilty of breaching health and safety laws. Individual executives were called to account.
In this case, the inquiry into the Mid-Staffordshire hospital has whitewashed away the concept of individual responsibility.
Why should it be exempt from serious political discussion?
Yet few Western countries come close to replicating the centrally planned approach to healthcare seen in the NHS – the fifth biggest employer in the world, the biggest in the UK (indeed in Europe) and the world’s biggest healthcare provider ( in the 22nd largest country by population).
You’d think that discussions about health policy in the UK would include the point that a majority of developed countries have insurance based models, and have private hospitals providing health care on a wide scale. No. The counterfactual constantly raised by NHS lobbyists and supporters is the US, itself a mix of corporatist private health care supported by tax breaks for employers, and an uncapped pair of state provided health care through Medicaid and Medicare. Half of the US healthcare system is taxpayer funded. Yet I know of no one who would say the US is a suitable model for others. However, a look at Singapore or Switzerland presents an alternative.
In both countries healthcare is universal, but only because instead of taxpayer funding, individuals are required to take out health insurance, with insurance for the poorest topped up by taxpayer subsidies. As people have a choice of health insurance providers, and options to buy more care, there is competitive funding and through insurers, competitive delivery. At a simple level you can’t even choose a GP outside state determined geographic boundaries in the UK. Why?
It is time for a serious public debate, not about the NHS, as if it is the only option, but about health policy in the UK. It is time to talk intelligently about what is done in other countries, and to start to recognise that what is wrong with the NHS is its very core.
It fundamentally is not driven by what customers want, but by the demands of the closed shop of professionals interested in maintaining its virtual monopoly. Of course, precious few decision makers would do without their own private health insurance. Why shouldn’t everyone have the option to opt out of at least some NHS services and buy their own?